Healthcare Provider Details

I. General information

NPI: 1740537299
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2012
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343-2036
US

IV. Provider business mailing address

16111 PLUMMER ST BUILDING 10
SEPULVEDA CA
91343-2036
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax:
Mailing address:
  • Phone: 818-891-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number11181
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. MARTHA STEWART WAITE
Title or Position: CHIEF, SOCIAL WORK SERVICES
Credential: LCSW
Phone: 891-891-7711